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Declaration of Domicile and Citizenship i
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448555
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E COUNTY. FLORIDA: .
This is my declaration of Domict~e and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formerly a legal resident of ~L.F.v _ , _ j« a and I
. ICityl S (Stall)
resided at ~'¢'gi_ 1~',Q.t
r~.~~- ~ . However. I have changed my domic~7e b
(Street and Number)
and am and have been a bona fide resident of the State of Florida since 2 •1r day of {
~ , 19 7 ~ and I reside at g gl ~ ~1L~ Ste" .
(Street and Number)
~~.r r S>- . !u ST . L UG i E County. Florida,
Lcity)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domic~e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL., PEEASE STATE PLEASE CHECK:
THEIR NAMES:
jig ,,',~!:i 20 X1(4 53
IiLLJ 1. ii, {`CC.Uht~lV
~1. ~~rR
Pj01TRA A
h,.G_
k,_t
448555
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
i
I FURTHER CERTIFY that I have no intention to return to m_v former domicile, and I intend to remain in
T. U C I E .County,
F LCKy)
L
Florida, permanenti;.
i
~couNr CJ,~IIi~r>ti ~ G S
J~fr~"uEPr••.. ~/fir
- ° _
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•::.IY . (Nam.)
(Addreu)
Sworn to and subsrnbed befort me this ~ day of
9
~r..ra.. . A.D.19
; / /
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ROGER POI TRAS, CLERK OF G IRGUI T COURT
ST. LUG I E COUNTY, FtOR t OA ~ ~
BY: n ~ >
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_ EPUTY LERK
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